What Are Trigger Points?

If you've had a massage at least once, you're probably familiar with trigger points in some way. Whether you knew they were there, or got caught by surprise when your therapist found one, much of your musculoskeletal pain can be concentrated in these overly irritable spots. But what exactly are trigger points, and why are they so painful? 

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What Are Trigger Points?

Trigger points are areas of increased muscle tension. We notice them when they appear as "knots" of tight, painful tissue in the myofascia, and they often develop in the centre of the muscle. Sometimes, a muscle may have a chain of trigger points, or multiple knots in different areas. Other times, trigger points may feel like tight bands. I commonly see a cluster of knots in the hamstrings, which are worse in people who stand for long periods. Both clients with stiffer connective tissue and those with hypermobility develop trigger points, and it doesn't matter how much muscle you have, either. 

But What Causes Trigger Points? 

Overuse, a lack of exercise, injury, stress, aging, poor posture, joint problems, chronic musculoskeletal diseases, and vitamin deficiencies can all contribute to the aggravation of trigger points. We don't know for sure how they turn on, but the integrated trigger point hypothesis is the most accepted theory today. Here, overactive muscle tissue becomes permanently contracted, resulting in less oxygen and nutrient supply, with more inflammation and metabolic demand. Testing shows that this mostly originates from the connections between nerve cells and muscles. Some research also suggests a role for central sensitisation, where long-term or intense pain causes the nervous system to become over-sensitive. 

How Do I Know If I Have Trigger Points? 

Everyone has trigger points, but they won't always bother you. If they are severe enough, trigger points can cause pain and stiffness throughout the muscle and possibly referred pain in different areas. They can impair movement and posture, and may worsen issues such as TMJ dysfunction and headaches. Other times, you may only notice knots and overall tension during treatment. If this is you, then you have latent trigger points, which may still affect the strength of movement or disrupt normal muscle activation patterns. 

How Do You Release A Trigger Point? 

Massage therapy is the best way to release an aggravated trigger point, with the best prevention being regular stretching and avoiding incorrect movement patterns or prolonged immobility. The pressure placed on trigger points during massage creates a kind of rebound effect that is meant to restore at least some function and circulation to the area. I usually apply pressure to them with my elbow (to avoid straining my hypermobile thumbs), and I may do this once or twice for around 10-20 seconds each time. I always use Swedish massage techniques to relax the musculoskeletal and nervous systems before any trigger point release or myofascial release, to avoid causing more tension. 

Trigger points don't completely disappear, as they can still reactivate when they're exposed to whatever first caused them. Your muscles need to carry some tension, but an excessive amount is what causes symptoms such as pain and poor mobility. 

Overall, while trigger points are normal, allowing them to get out of hand can contribute to pain, poor physical function, and even certain health conditions. Regular stretching and massage therapy are the best ways to manage them, and you may see the benefits build up over time.